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626 Sparks Rd (2) ,-- -,., DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street . Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT �ccc�u�t �: 990005826 'T�x F'I�€i�H#: B60000002506 �iiled To: Achan Smith .. . : Su�adi�i�iaii lnf�: . . . Refer�r�ce Na��e.: . , : ::LacationlAddr�s�: 626 A Sparks Road-27028 ; . � . � F�ro�c�sec9 F�cility: Residence . : I��o�er�y�Siz�: 5 Acres , �,T�*'��*T'h���uance of this Operation Permit shall iridicate the system described on the ATC has been`installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. ' System Type:�S.T.Manufacturer��;� Tank Date �—? Tank Size 10C�D Pump Tank Size / System Installed By: C�' �Qb' v�. E.H.Specialist: � ate: D� GPS Coordinate: �s�,9� `'�� -`" 7i' V� � . � / � ` � V� � DCHD 11/06(Revised) . DAVIE COUNTY ENVIRONMENTAL HEALTH • P.O.Box 848/210 Hospital Street Mocksville,NC 27028 _ (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION . �c�t�u�t #: 990005826 T�x PiNi�H#; B60000002506 Billcd To: Achan Smith ... :Sufadivisiort Infc�: . R�fer�rtce Nanie: . .. . '. LocatioNAd�r��s: 626 A Sparks Road-27028 _ � Pro�ased Facifify: Residence : . . . �: P�oper#y Size: 5 Acres .. . Site Type: f,�New ❑Repair ❑Expansion t�TC Nurnber: 5885 . . . . .. **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatrnent and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat � or the intended use change. Residential Specifications: #Bedrooms #Bathrooms #People Basement❑Basement plumbing❑ Non-Residential Specifieations: Facility Typ S� #People #Seats _Square Footage(or Dimens ons of Facility) Lot Size��_ Type of Water Supply: ❑County/City 0 Well ❑Community Well System Specif cations: Design Wastewater Flow(GPD),�� Tank Sizel�d GAL.Fump Tank�GAL. Trench Width�� Max.Trench Depth�(��` Rock Depth�/A Linear Ft. Site Modifications/Conditions/Other: - Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. � ' . � �� o � �f h � �-'� 5 - 1� � �-�- �P°�� � - . . � . Environmental Health Specialis Date: 2�� DCHD 1 I/06(Revised) ' � � � DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 . (336)753-6780/Fax#(336)753-1680 AUTI30RIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Accc�unt #: 990005826 T�x P1N:EH#: 660000002506 BiEI��To: Achan Smith .,., ;Sufa�ivis�ort Info: :. . R�fer�r�ce �l���e: . _ _. :- .LucatianlAddr�ss: 626 A Sparks Road-27028 � ., : :;: . Propas�c� Fa�;i€ity: Residence :- :,:,.•� - ` � � , �:�, P�o�erty Size: 5 Acres _ � : , : : : Site Type: f,�New. ❑Repair ❑Expansion ��T'C Nurnber: 5885 . . ... , . , � **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms #Bathrooms #People Basement❑Basement plumbing❑ Non-Residential Specifications: Facility Typ s� #People #Seats .Square Footage(or Dimens ons of Facility) Lot Size �Q�( Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)l�Tank Size��GAL.Pump Tank�GAL. Trench Width�� Max.Trench Depth�(��� Rock Depth /(,/� Linear Ft. Site Modifications/Conditions/Other: - Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. • � • - , �' ___..--.-- 0 ' ��h `'� Q�� 5 �� / G�P�E � , . �- Environmental Health Specialis Date: 20� DCHD 11/06(Revised) � , • • Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005826 � Tax PIN/EH#: 660000002506 Billed To: Achan Smith Subdivision Info: Address: 626 Sparks Road Location/Address: 626 A Sparks Road-27028 City: Mocksville Property Size: 5 Acres Reference Name: Propq��.��t�������c�ment Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to .� � revocation if site plans,plat or the intended use change. Permit Type: �New ORepair OExpansion Permit Valid for: tj15 Years �❑No Expiration � Residential Specifications: #Bedrooms #Bathrooms #People Basement❑ Basement plumbing0 Non-Residential Specifications: Facility Type ` �h� #People�#Seats � Square Footage(or Dimensions of Facility) Design Flow(GPD): �� Type of Water Supply: �County/City �Q,Well ❑Community Well Site Modifications/Permit Conditions: S stem T e LTAR Initial S°p ` Re air 4 .Site Plan . � � � �J` : ' I�� e�� �� � . '� �� �� `� �� ;�" . . � . . �`� . , � ��� c �� . Environmental Health Specialist • Date� 2C�1 Z i.p.l 1-06, . . . Feb 2B 12 09:15a irlortnation Services 3387531880 p�� . . •. .. . . �, • ' ApPLICATION�OR SIT�EVALUATION/IMPROVEMENT PERMIT&ATC , ' Datiic Coanty Enviconmcntal Hcatth ����� P.O.Box 848/2I0 IIospital Stecet � Mocksvillc,NG 27028 7 . (33�753-6780/Fax(336)753-1680 � F�e � n z41z b`� npplication For. O Si�c f:valuationllrnprovcmrnt Pamit U Authorizacion To Construc4(rlTC) �.Bolh -• T�pe ofApplicaeion; L�Trew System ❑Repair to Facisting Systcm Uf;xpansion/Mexlifieation of�xini�g System or Faci�tyr� ••'IMPORT�tN7'"*THIS APPL1CA770N G�VNOT BEPRUCESSED tINLB$$A�.L OF Tt�ILEQUIRED lYFO1tMAT10N iS PR�Vi17ED. Refer to the INFnRMATION F�ULLfffM for iastcucti�s. . A1'PLfCANT INFOItMAT10T Nflme L�� J�Y�1 Contact Pexson ��.�'►1 JYY11� Address E�s' 3 av 5 Home Phone �320 9 LI'� ,�,�(�(_ CitylStatclG(P o� �i -� l3u�incss Phone __,. Name on PennidATC ifD�e�cnl U�an Above MaiGng Add�ss __ City/5tateJZin___ : ,� . .� _. PROz'ERTY INFORMATION 'Datc ElousdF'acilitv Comera FI.� ed NOTC� A survcy plat or a�le plan musc accompany chis application. lncluded:fl Slcc�'inn 0 Plat(to scak) (P�r►it is v lid or 60 m ndts 'th site pinn;no cxpirarion widi coulplete plat_) �� � Owner's Namc �fl�� ph�ne Nu bc;r ��� � Owncr's Address Ciry/StauJZip � �� G _ "La2. ( PcopartyAddress o 5 City • Q�b����r/ Lot Size S n C h 5 7:tx PIN# .1/ Subdivision Npme(iFa licable) Section/LotM DireCtions To Site: �g 1►.ir O QO�� —�f)1n ��M�- R oh $ r w ,• af„ If the enswet t xny of the followingquestiona ia�`Yes",sugpprttng cumcntwtion must bc attachod: �� An ihae arry cxistitu;wa�tewate�systems on the sitcY xYes No Does the si�c connin jurisdi�tional wetlaads? Yes�No , Am thac any eascments or righ�-of-wqys'on the site7 Ycs No is the sitc subjxt to xpproval by another public agcncy? _Ycs�4 No W iU wasttwaccr oflxc thati domestie sewagc be geaczated? _Ya�QNo IF R�.SIDENC�FIL!OUT THE ROX BEbOW �Pcoplc fi Bedrooms �! #Bathtoouu Gatden Tub�'Whiripool f1Ycs �No� 8a.aement:OYes?�No 8asementPlumbing: I lYcs �ri10 _J IP NON-ItESiDEIVCF.FIL OUT THE BOX BELOW � Type of FaeilityBusirtess �b Tota1 Squace Poo'tagc of Buildin� #People *Sinlcs�,� tf Commodes it Showrrs� �, /.�Urinnls��� Estimated Water Usage(gallons per dny)_ �� _(Attach documontation of similar faeiliry water consumption) FQODSERV]CE ONLY: #Seats Type systrm rcquested; JComentional'�Accepted 0[nnovetive pAlurnative- �qher • •-- --..._... . . . .. .. . .. . ` � •s �Vater Supply Type;Cl CounryrCi�v Watcr Cl Ncw Wcll �.xiSCng Well f]Communily Well D�you antieipa�eddilio�s or exn�naians af thv fWCilily thi�sysum is intendod to arnc?l�Yes i�Nu Tf yes,wlvU typc? , _ , 'Chis ig to eertify that ih�infotmation provided ort lhis application is true ond currcct to lht best of my krtowloclbc. I undttsLmd ilult uny perTnit(s)Or ATC(5)issucd hcrrzfter ue Subject t0 SuSp�:rlsion or rcvoCation if thC SitC is tdtaal,Uie intended use changes,or if the informaiion sub�aiued in this appl;raticm ix CalsiGnd or changed C htrcby�rant right of entry to du Authori2nd ReprcccnWtive of the O:vie County Hcalth[kpariment to conduct neeess3ry inspecGons ta detennine comptiance with applicabin laws tules. T undasL tlut 1 tm respomibla for thc proper ideatiGwtion und L►belins af pcopccry lin�and conters nnd lxa n a d�le ' or in thc houu•lfaciliry location,propoxd wcll location aad the loeatioa oFuny other amenities. � L' ' .Stf�',[�Ylilt C�IM�'.0 Properiy o ur's or owner's te al cept��ative�ibmature pate(s): �'�.�'�2, Clicnt Notification llute yate E�� Sign given UYcc:1No Accounl K J�� _ I Revised U/Ob Invoicei� �-�� GoMAPS - Davie County NC Public Access . � � � �';"I WATERSHED STRUCTURES , � , f� { �� � ; WATER BOD�ES • � S __. �: + ; � � COUNTY_BOUNDARY _ ;i' �� A ADDRESS � . � ;;' 1 y,� �� DRfVES � � � }` -- � STREETS �� � � tk.''' RAILROAD CENTERLINE , • ,;' � � i.� - , S ti a PARCELS � �G�t�� , �1 CITY_LIMITS f �+ BERhfUDA RUN �`Y� � � COOLEEM1tEE 1 r � � onviE couNrr f'] ` ~} 1 � h10CKSVILLE V r 1 ��� � 1 nccounties � � DAVIE � � <all other values> ` - _,. l . v:5�9-"� . 1'r5P P�-"� .� � . . 1 1 / t E� ;1 oiz2tt ***WARNING:THIS IS NOT A SURVEY!*** Wednesday,February 29 2012 This map is prepared for the inventory of real property found within this jurisdiction,and is compiled from recorded deeds,plats,and other public records and data.Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map.The County and mapping company assume no legal responsibility for the information contained on this map. � �� �, a � , , , , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005826 Tax PIN/EH#: 660000002506 Bilied To: Achan Smith Subdivision Info: , Reference Name: Location/Address: 626 A Sparks Road-27028 Proposed Facility: Residence Property Size: 5 Acres Date Evaluated: Water Supply: On-Site Well 1� Community Public Evaluation By: Auger Boring /� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition (.. L Slo % C9 ° HORIZON I DEPTH � _ p Texture rou Consistence Structure � Mineralo . � ( � • HORIZON II DEPTH - Texture rou - - - Consistence F Structure -►uQk Mineralo �: l , HORIZON III DEPTH Texture rou Consistence Structure � Mineralo � HORIZON IV DEP'TH Texture rou Consistence Structure Mineralo - SOIL WETNESS RESTRIGTIVE HORIZON SAPROLITE CLASSIFTCATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �S . EVALUATION BY: �G � LONG-TERM ACCEPTANCE RATE: -��_ OTHER(S)PRESENT: � L REMARKS: a ►`�-� I'�� LEGEND Landscane Position R-Ridge S -Shoulder L-Lineaz slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-F1ood plain H=Head slope �g � S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam - CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSIST .N . MMQISL , VFR-Very friable FR-Friable FI-Firm VFI-Very fum EFI-Extremely firm � � NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic � SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic . • Mineralogv � 1:1,2:1,Mixed LiQt� , Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR/-Long-term acceptance rate-gaUday/ft2 �� . 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